HomeMy WebLinkAboutMortgage_Cundiff (3)"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ip vear
; FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn G3709 (R11 / 6O9)
�' Prestribetl Ey DeparVnenl of f.n(al GovemmeM France
File Mark
wsrnucnoNS: FEB 1
b 6e filed in rson w b mail with the Coun Auddor or Coun Recorder oI the coun where the ����
Pe Y �Y b b P�A�rt1' is locared.
Fil'ug Dates: 1) Real Property Must fde durbg fhe year lar which the deduction is sought C.�. Cpun AudROr
2) MobRe /Manufadured Homes not assessed as Real Property: Must fJe during the nvelve (72) months ry
6efore March 31 0/ each year the deduction is saghL County Recorder
See reverse side fa additional instrucUons and qualificafions. GI BSON COU
AppGmnt (owrreror mnlraC buyer. see re5ri�ons m reverse siM)
. �
a' �strirl , Key'wmEer / legal eSaiGtion Reco�d wmDPi Pa9e numDpl �
a �/ - 0 7- 3o3-odo. /3 /_o �8 p i O �a as
Assesud value d real paperty as of Mwigage / Contracl'uWebtetlness unpeid as of Mortgaga I Conva�Y uWeMedness impaid as d Is Ihe appfionl Na sola
nlaa� �. a.m,rc yra. rnarai �, currem r� aate or acWk�� �ea� «ewaawc o�nnn
�� 0 0 Q ❑ Yes ❑ No
J n0. whaf is his / hu e�mu share ot intexv? rc wmm wim someone oNer Man wW�. 4dkate wiC� wMm
If rwne on remrd is QAterant than that o7 aDW��. u�dirate belmr. ,I-s. �tlie DroP�Y in Question: Mnua�Y Assessed
� neal Pmperty ❑ Armually Assessed
Wme oi rt�ortgagee «mnrst seAu
Address of moit�agce w cantrad seAer (nuMer end sbee; rAy, slate, aM LP code)
Nama W assj§r1Ee a� er a/ rtprtg
� t-� �/7�
�� v �
Mtl�ass of a�9�� (num6ar entl street �1: state.
Mam wm P�P�Y in a�7 aher
Indena?
0 Yes
Dedu�tion apryoveC In Me amoun[ at
20 _
y�ahae U Counb Audifnr,
�.T� �
I/ We certify under fhe
owner I mntract buyer
Dra�vcr \'0...�010.......
Ifyes.whatmunfyt WhatTaringDisvi /^1��
No Cal'C] \r . ... �i1
. ................
�s3, �yi�
cour+rr nuorroa
20 � 20
�c s�� [.u�s� r, �
Pe�sm autM'ved �y OWy ezewtetl f
that the
person (numbcr antl sLSe; ciry,
20 � 20
Counry
p_
Date (nm)h, daY. Y��
20 _
foregoing infortnation is W e antl cortect and Mat Me applinnt is a residerrt of IMiana and
P apD��tiun is filed.
ZIP wtle) 'I
fA]r��-vr. ��.i 't-l(o1D
or by IC Ft. t42-07
Date (mmfi. daY Y��
Y
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